Food policy clinics at the Harvard and Vermont law schools have issued a new report—interactive no less.

The report argues that

our food system often works at cross-purposes, providing abundance while creating inefficiencies, and imposing unnecessary burdens on our economy, environment, and overall health. Many federal policies, laws, and regulations guide and structure our food system. However, these laws are fragmented and sometimes inconsistent, hindering food system improvements. To promote a healthy, economically viable, equitable, and resilient food system, the United States needs a coordinated federal approach to food and agricultural law and policy – that is, a national food strategy.

The strategy needs to focus on :

Coordination: Create a lead office and an interagency working group, and engage local governments.

I know about this book mainly because my NYU colleague Marie Bragg and I have a chapter in it, “The politics of government dietary advice: the influence of Big Food.”

The book is meant to introduce readers to the field of food sociology through themes. It divides chapters by various authors into three sections: the social appetite, the food system, and food culture.

Its aim is

to make the sociological study of food relevant to a multidisciplinary readership, particularly those across health, nutrition, and social science disciplines. Our further aim is to reach a broad readership so that those interested in food, nutrition, and wider issues of food production, distribution, and consumption can discover the relevance of studying the social context of food.

The chapters plunge into the controversies and come with summaries of the main points, sociological reflections, discussion questions, and ideas for further investigation.

The sociological reflection on Marie’s and my chapter says:

Dietary guidelines and food guides, although apparently “science-based,” are created by individuals who serve on government committees and are subject to the same kinds of influences as any other members of society. Because the food industry is the sector of society with the strongest stake in the outcome of dietary guidance, government agencies and committee members are strongly lobbied by industry. Controversy over dietary advice derives from the contradiction between the health-promoting goals of public health and the profit-making goals of food companies.

If you are looking for a quick introduction to food sociology, here’s a place to begin. The editors are Australian academics so there are plenty of Australian examples.

In this welcome addition to my library of books about food policy and politics, Steve Clapp’s Fixing the Food System reviews the past and current history of calls for a national food policy, the most contentious controversies over food and nutrition issues that have impeded development of such a policy, and the work of advocates to achieve one. As this book makes clear, this history began decades ago.

I first became aware of the importance of federal food policies in the early 1980s when I was teaching nutrition to medical students at the University of California San Francisco (UCSF). First-year students were eager to learn about nutrition, but for personal more than for professional reasons. They wanted to know what they—and the patients whose health problems they were learning to treat—should eat. But by the time they were residents, I could see their dietary concerns vanish under the daily demands of patient care. Trying to advise about diets was too difficult, time-consuming, and financially unrewarding to be worth the trouble. It seemed unreasonable to expect doctors to take the time needed to counsel individual patients about the prevention of diet-related conditions—heart disease, type 2 diabetes, cancer, and the like. If nutritionists like me wanted to focus on disease prevention rather than treatment, we would have to advocate to change the food environment to make healthful food choices the easy choices—even better, the preferred choices. This meant we would have to advocate for food and nutrition policies aimed at promoting public health.

In 1983, I co-authored an article with UCSF colleagues on the need for such policies.[i] It began:

The U.S. government helps to assure an adequate food supply for Americans by sponsoring a wide variety of food, nutrition, and agricultural support programs. These federal activities were developed in the absence of a clearly articulated national policy, a situation that has resulted in the fragmentation of government programs and their wide disbursement among numerous agencies and departments.

Our article quoted the earliest calls we could find for a national policy to address these problems. In 1974, long before the term “food system” came into common use, the National Nutrition Consortium of four leading nutrition and food science societies[ii] argued for a national nutrition policy that would:

Assure an adequate, wholesome food supply, at reasonable cost, to meet the needs of all segments of the population.

Maintain food resources sufficient to meet emergency needs and to fulfill a responsible role as a nation in meeting world food needs.

Develop a level of sound public knowledge and responsible understanding of nutrition and foods that will promote maximal nutritional health.

Maintain a system of quality and safety control that justifies public confidence in its food supply.

Support research and education in foods and nutrition with adequate resources and reasoned priorities to solve important current problems and to permit exploratory basic research.

Whether offered as nutrition or food policies, these were and remain highly appropriate goals for an abundant, healthy, safe, and effective food system.

My co-authors and I went on to identify the constraints that then limited government action to achieve such goals. Despite an emerging consensus on the basic elements of healthful diets—fruits and vegetables, balanced calories, not too much junk food (as Michael Pollan put it more recently, “eat food, not too much, mostly plants”[iii])—the greatest impediment to policy development was the controversy over the science of diet and health. As our article understated this issue,

The effect on the nation’s health of food processing and other changes in the U.S. diet is controversial. Salt, sugar, fiber, saturated fats, alcohol, caffeine, calories, vitamins, and food additives all elicit vigorous debate.

Today, more than 30 years later, we are still arguing about that science, and the scientific arguments still impede policy development. In Fixing the Food System, Steve Clapp brings us up to the minute on federal progress (or the lack thereof) toward achieving a clearly articulated national food policy. He begins and ends his book with the most recent policy proposals from leading food advocates Michael Pollan, of course, but also Mark Bittman, Olivier de Schutter, and Ricardo Salvador. Their recent suggestions for improving our current food system reflect the many changes in agricultural production and food consumption that have taken place since 1974 but retain the basic elements of those earlier proposals. Fixing the Food System explains why a national food policy is so badly needed and matters so much.

Steve Clapp is in a unique position to comment on food policy issues. He’s been at the policy game for a long time. I don’t remember when I first met him but I have been reading his work since he reported for the Community Nutrition Institute’s newsletter, Nutrition Week. For those of us outside the Beltway in those pre-Internet days, Nutrition Week was a lifeline to the ins and outs of food politics in Washington, DC. Later, when Steve moved to Food Chemical News, also—and still—a lifeline, I continued to read his reporting. I often ran across him at meetings and hearings in Washington, DC and found it instructive to read what he wrote about those deliberations, not least because he got it right.

I say all this because he has been a keen observer of the food politics scene in Washington for decades and I can’t think of anyone who ought to know it better. Fixing the Food System reviews the major debates he witnessed—the Dietary Guidelines, of course, but also attempts to set policy for food safety, marketing to children, hunger in America, and humane treatment of farm animals, among others.

Over the years, he also observed the work of policy advocates, and this book includes profiles of many individuals engaged in this work, some likely to be familiar to readers, whereas others may not. Impossible as it is for me to judge whatever impact my own writing and advocacy might have, I am honored to be included among those whose work he presents.

Fixing the Food System describes political arguments over the kind of food system we ought to have and what an ideal system should accomplish. But it is also about the importance of personal and political advocacy for a better food policies, those aimed squarely at promoting public health and environmental sustainability.

Advocacy makes a difference. Advocates are scoring successes in improving one after another aspect of the food system. In comparison to the 1970s or 1980s, we now have better food in supermarkets, more organic foods, more farmers’ markets, more nutritious food in schools, and impressive declines in consumption of sugary drinks. My personal favorite among indicators of advocacy success—the change that makes me most optimistic—is the increasing number of college students who care deeply about food issues. They are demanding local, seasonal, organic, and sustainably produced food in their cafeterias, and campus vegetable gardens. And they are demanding and getting food studies courses and programs like the ones we started at New York University in 1996 that teach about how food is produced and consumed and the practical and symbolic meanings of food in modern culture and societies. Today’s students are tomorrow’s advocates for healthier and more sustainable diets for everyone, everywhere, and for fixing what needs fixing in our food systems. This book is a great starting place for this work.

[ii] National Nutrition Consortium, Inc. Guidelines for a national nutrition policy. Nutrition Reviews 1974;32(5):1253-157. The Consortium included the American Institute of Nutrition, the American Society for Clinical Nutrition, the American Dietetic Association, and the Institute of Food Technology.

The world now experiences two forms of malnutrition which may seem contradictory: “undernutrition” (which includes micronutrient deficiencies) and “overnutrition” (obesity and its health consequences).The problem of malnutrition in developing countries is approached by most aid bodies (donors, international organisations and NGOs) and governments solely from the angle of undernutrition. And yet in these countries, the complex and multi-faceted challenge which malnutrition now presents can justifiably be called the double burden of malnutrition. In addition to the continuing problem of undernutrition there are now major issues linked to overnutrition and its associated illnesses.

Rapid nutrition transition

The stereotyped image of skeletal young children with protruding bellies saved by souls of goodwill in sub-Saharan Africa is still too widespread. Severe acute malnutrition still persists of course, especially among the victims of extreme poverty, natural catastrophes and wars. Naturally, this deadly disease must continue to be addressed and treated, as numerous NGOs are doing.

The treatment of malnutrition should focus not only on severe malnutrition in children. Less severe malnutrition, going back to life in the foetus and resulting from malnutrition in women even prior to their pregnancy, continues to contribute to stunting, which affects 23.8% of all children under the age of 5 throughout the world.

In parallel with acute and chronic undernutrition, the “nutrition transition” in low-income countries, driven by globalisation, urbanisation and technological progress and linked to “overnutrition,” leads to a swift increase in obesity and other chronic diseases – mainly diabetes and cardiovascular diseases. Nutrition transition is the term used to describe the progressive Westernisation of eating patterns, typified by a sharp increase in the consumption of animal fats and processed foods all over the world, combined with an increasingly sedentary lifestyle. It is easy to see how this transition encourages the increase in overweight and obesity.

Today, undernutrition alone is not the major issue; the greatest problem is the double burden of undernutrition and overnutrition. According to estimates from 129 countries with available data, 57 experience serious problems of both undernutrition in children and overweight in adults[i]. And Africa is not exempt from this double burden where undernutrition and overweight are undeniably linked. In West Africa, 50% of women of child-bearing age are anemic while at the same time 38% are overweight and 15% are obese. For the whole of sub-Saharan Africa, 40% of children have stunted growth characteristic of chronic undernutrition, while 7.5% of adults suffer from obesity. Malnutrition early in life increases the subsequent risk of chronic diseases in places where obesity is encouraged by the environment. Obesity is now on the increase among children in all developing countries. The World Health Organization (WHO) reports that between 1990 and 2015 the number of overweight or obese African children doubled from 5 to 10 million.

The responsibilities of the industrial food system

It is often said that communication aimed at changing food habits is the best way to prevent obesity, a problem reserved for rich people in low-income countries. This cliché contains three errors:

The first is the claim that preventing nutrition-related chronic relies entirely on the capacity of individuals to make appropriate choices regarding food, physical activity or lifestyle. This claim ignores the well-documented effects of the food system and the socio-cultural factors which play a determining role and which influence the choice of individuals.

The second error is to believe that significant changes cannot be made to the eating practices of limited-income groups in the absence of an increase in resources. Yet several studies show the opposite, whether they are about exclusive breastfeeding for the first six months of life and improved complementary feeding, or else hygiene measures and supplies of drinking water.

The third error is to consider that obesity continues to be only a problem of the rich in low-income countries. Obesity is escalating and affecting growing numbers of not so well-off people, particularly in cities.

When analysing the impact of the food system, it is necessary to account for the agri-food industry (Big Food). On a world-wide scale Big Food is primarily responsible for the “nutrition transition” towards processed food. “Globalised” industrial food is gradually replacing traditional cooking and locally produced foods, with ultra-processed foods’ (food-like substances as Michael Pollan calls some of them) undeniable appeal for city-dwellers and young people as these products are strongly associated with Western-style fast food and heavily promoted by the media. This appeal is reflected in profound changes in consumption trends in developing countries. Global sales of highly processed foods increased by 44% from 2000 to 2013, but only by 2% in North America as opposed to 48% in Latin America and 71% in Africa and the Middle East.

So what is the problem? Industrial food products (and drinks) are often a nutritional disaster: rich in calories, sugar, fat and salt, but low in essential nutrients and fiber. Even more, these products are relatively inexpensive, often less expensive than more nourishing local food products.

Changing the food environment

What is the explanation for the popularity of these “globalized” food products? Part of the answer lies in extremely effective advertising. Anyone travelling in Africa, for example, will see campaigns to promote salty stock cubes to replace traditional spices and vegetables. “Social marketing” efforts to change eating behaviour must be as forceful as these adverts, with commensurate budgets.

One idea is to impose a tax on soft drinks or other highly processed foods and use the revenues to finance cutting-edge nutrition education campaigns. This is what the United Kingdom has recently decided to do by taxing soft drinks.

It is especially important to rethink the nutrition programs created by NGOs and financed by international aid. Correcting the nutrition of malnourished mothers or children is only part of the problem.

A wider vision is needed to recognize the threat to world health posed by nutrition-related chronic diseases.

To cope with this new challenge, it will be important to address many determinants of health – education, social disparities, housing, and culture – as well as the food environment. The latest report on global nutrition1 points out the excellent return on investment of nutrition interventions (16 for 1), and challenges governments and decision-makers to identify and implement strategies that target the double burden of malnutrition. If this is not done, it will be difficult to reach the nutrition objectives set by the WHO for 2025 (see below). Solutions do exist, however, as can be seen from places such as Ghana, Brazil, or the state of Maharashtra in India, which have had encouraging results in fighting malnutrition in all its forms.

Global nutrition targets for 2025

Reduce the number of children with stunted growth by 40%

Reduce and keep the prevalence of acute malnutrition in under-five children (low weight) under 5%

Avoid any increase of overweight in children

Reduce the prevalence of anemia in women of child-bearing age by 50%

Increase exclusive breastfeeding for babies less than 6 months old by 50%

Reduce low birth weights by 30%

Avoid any increase in the prevalence of overweight, obesity and diabetes in adults.

The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.

As she explains, Latin America is leading worldwide opposition to food industry marketing, and much is happening in Brazil.

She writes about the advocacy work of Carlos Monteiro, Professor of Nutrition in the School of Public Health, University of Sao Paolo, who says:

The local food system is being replaced by a food system that is controlled by transnational corporations…this dietary deterioration doesn’t just harm bodily health but also the environment, local economies, and Brazil’s rich food traditions. We are seeing a battle for the consumer.

She further explains:

Over the last 30 years, big transnational food companies have aggressively expanded into Latin America. Taking advantage of economic reforms that opened markets, they’ve courted a consumer class that has grown in size due to generally increasing prosperity and to antipoverty efforts like minimum-wage increases and cash transfers for poor families. And as sales of highly processed foods and drinks have plateaued (and even fallen, in the case of soda) in the United States and other rich countries, Latin America has become a key market…In recent years, Brazil has inscribed the right to food in its Constitution and reformed its federal school-lunch program to broaden its reach while bolstering local farms.

And in 2014, the Ministry of Health released new dietary guidelines that made healthy-food advocates across the world swoon [I did a post on them when they were released]. Monteiro helped lead the team that wrote them; the guidelines transcend a traditional nutrition-science frame to consider the social, cultural, and ecological dimensions of what people eat. They also focus on the pleasure that comes from cooking and sharing meals and frankly address the connections between what we eat and the environment.

Huber’s investigative report is long and detailed, and well worth the read.

And it comes with a great graphic comparing the situation in Brazil with that of the U.S. (this is just an excerpt):

Those of us advocating for food systems that are healthier for people and the planet have much to learn from our colleagues in the South.

Roni Neff, editor. Introduction to the U.S. Food System: Public Health, Environment, and Equity. Johns Hopkins Center for a Livable Future, Jossey-Bass, 2015.

This is an undergraduate textbook for students in courses dealing with almost anything having to do with food as it relates to larger societal issues of economics, policy, marketing, culture, security, health, and the environment. It is large (542 pages, 8.5 x 11), easy to read, and well illustrated. It ought to be terrific in stimulating thinking about these issues, particularly because it covers everything you can think of that’s important in this area, from farm subsidies to school lunches. The only thing missing is international dimensions, but that would take another book of this size.

The report is enormous (my paper copy weighs more than 5 pounds) and it is about as wonky as these things get.

It’s underlying purpose is buried in the Preface.

The U.S. food system provides a remarkably varied food supply to the U.S. consumer at lower cost than nearly anywhere else in the world. Many are concerned, however, that the cost of food in the marketplace may not reflect its true cost. Some of the costs of food production and distribution are not reflected in the marketplace price of food but are “externalized,” borne by other aspects of the health, environmental, and social domains of our society.

This report is about how to establish a basis for calculating the true cost of industrial food production.

The committee did not actually calculate such costs. The report just says what researchers need to consider when making such calculations.

Even without having done that work, the report is a fabulous resource for understanding the the effects of the US food system on health, economics, the environment, and society.

It establishes the framework and explains how to use it:

Recognize effects across the entire food system

Consider all effects

Account for complexities

Choose appropriate methods

Reading through this takes some doing. Here, for example, is what it says about using the framework:

The framework provides a set of design considerations for planning an assessment of the food system across the domains of health, environmental, social, and economic effects. It invites the user to think explicitly about system boundaries, dynamics, heterogeneity across space and populations, and the range of driving forces that shape food system outcomes…What this framework suggests is that all else does not remain equal and that any meaningful assessment must consider the likely and unintended consequences of proposed change for the status quo when its performance is in question.

The report gives specific examples of how the framework works for examining the effects of advice about eating fish or fruits and vegetables or changing the way hens are caged.

An Epilogue has some concluding thoughts. Some selected examples:

Comprehensive studies of food systems that use all principles of the committee’s framework are rare in published literature.

Policies or actions that aim for an outcome in one domain of the food system (e.g., health) can have consequences not only in the same domain, but also in other ones (e.g., environmental, social, and economic domains.

Even though major improvements in the U.S. food system have resulted in the past from the introduction of new technologies, needed future improvements in the system may not be achievable solely through technological innovation and may require more comprehensive approaches that incorporate non-technological factors to reach long-term solutions.

The report ends with some recommendations, among them:

The committee recommends that Congress and federal agencies continue funding and supporting the collection (and improvement) of federally supported datasets that can be used for food system assessment studies along with consideration to creating new data collection programs as priorities arise.

The committee also notes the need to build human capacity in the field of systems science research.

The committee intends the report to stimulate broad thinking about the consequences of food system policies and actions beyond a single dimension.

OK food system analysts: get to work. Find out what industrial food production really costs—economically, socially, and environmentally.